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Republic of Rwanda
MINISTRY OF HEALTH
ONE HEALTH STRATEGIC PLAN (2014-2018)
“No single individual, discipline, sector or
ministry can pre-empt and solve complex
“health” problems”
Rwanda One Health Country Steering Committee.
Rubavu, 7th
February 2013
Foreword
Today, the world is facing numerous challenges that require multi sector and global solutions. One of
these challenges is the occurrence and spread of infectious diseases that emerge or re-emerge and have an
effect on humans, ecosystem interfaces, wild and domesticated animals. This is mainly attributed to
several factors including the exponential growth in human and livestock populations, rapid urbanization,
rapidly changing farming systems, closer interaction between livestock and wildlife, forest encroachment,
changes in ecosystems, the globalization of trade of animals and their products..
Worldwide, lessons learnt from the prevention and control of Highly Pathogenic Avian Influenza H5N1
highlighted the need to shift to an integrative and holistic approach such as the One Health approach.
With increased global human activity on the environment and the global movement of people, increased
trading of animals and their products, Rwanda is susceptible to the occurrence and spread of emerging
and re-emerging infectious diseases that can have a disastrous on the socio-economic growth. To
overcome this challenge, the Ministry of Health in collaboration with other stakeholders developed the
Rwanda One Health strategic plan.
The One Health Strategic plan reflects shared commitments to enhance collaboration between
environmental, animal (wildlife and domestic) and human health, and strengthening the new one health
workforce capacity through higher institutions of learning. The strategy also outlines interventions to be
undertaken by government institutions and other partners to enhance existing structures and pool together
additional resources to prevent and control zoonotic diseases and other events of public health
importance.
Successful implementation of the strategy will contribute to the realization of vision 2020 by improving
public health, food safety and security,and hence significantly improve the socioeconomic status of the
people of Rwanda. It is in this regard that I call upon implementing institutions, bilateral and multilateral
partners, civil society and the private sector to join us in implementing the One Health strategy in
Rwanda.
Dr. Agnes BINAGWAHO
Minister of Health
Table of contents
I. Acknowledgements ............................................................................................................................... i
II. Executive Summary ............................................................................................................................. ii
III. Table of Abbreviations and Acronyms ................................................................................................. v
IV. List of Institutions that participated in the Strategic Plan ................................................................... vi
V. List of documents used (see references) ............................................................................................ vii
1. Introduction ........................................................................................................................................ 1
1.1 Context and rationale .................................................................................................................... 1
1.2 Zoonotic diseases and one health .................................................................................................. 3
1.3 Environment and one health .......................................................................................................... 3
1.4 Climatic changes and one health .................................................................................................... 4
1.6 Food security, Food safety and One Health .................................................................................... 5
1.7 Economy and One health ............................................................................................................... 5
1.8 Lessons learned from preparedness and response to Highly Pathogenic avian influenza H5N1
(HPAI H5N1) ........................................................................................................................................ 6
1.9.1 Common Grounds to establishing Vision, Mission and Goals ....................................................... 8
2. Situation Analysis ................................................................................................................................ 9
2.1 Ministry of Health .......................................................................................................................... 9
2.1.1 Emerging Infectious Diseases .................................................................................................. 9
2.1.2. National Reference Laboratory (NRL) ................................................................................... 11
2.1.3. Environmental Health and Hygiene Desk (EHD): ................................................................... 12
2.2. MINAGRI/ RAB ............................................................................................................................ 13
2.3. Rwanda Development Board - Conservation ............................................................................... 15
2.4. Education Sector; ........................................................................................................................ 16
2.4.1. University of Rwanda (formerly Umutara Polytechnic (UP) and School of Publich Health) .... 16
2.5 Rwanda Environment Management Authority ............................................................................. 17
2.6. Collaboration .............................................................................................................................. 18
2.7. General Situation Analysis Summary ........................................................................................... 19
3. One Health Strategic Plan .................................................................................................................. 21
3.1. Vision ...................................................................................................................................... 21
3.2. Mission ................................................................................................................................... 21
3.3. Goals and Objectives ............................................................................................................... 21
3.4. Guiding principles ................................................................................................................... 23
3.5. Implementation Framework ....................................................................................................... 24
3.5.1. Governance and Management ............................................................................................. 24
3.5.2. Strategy and Partnership ...................................................................................................... 26
3.5.3. Resources mobilization ........................................................................................................ 26
3.5.4. Monitoring and evaluation ................................................................................................... 26
3.6. Strategic Logic framework (objectives, actions, indicators) .......................................................... 28
3.7. Budget (in RWF) .......................................................................................................................... 45
3.8. Appendices ................................................................................................................................. 60
Table 1: .......................................................................................................................................... 60
Table 2: .......................................................................................................................................... 60
4. References ........................................................................................................................................ 62
i
I. Acknowledgements
Special appreciation goes to the following institutions and organizations : Rwanda Biomedical
Center, Rwanda Agriculture Board, Rwanda Development Board (Tourism and Conservation),
University of Rwanda, Rwanda Environmental Management Authority, Rwanda Civil Society
Organization, CDC, WHO and the team that worked tirelessly to develop the One Health
strategic plan.
In addition, we thank USAID- Epidemic Pandemic Threats/Respond and One Health Central
Eastern Africa (OHCEA) Network, for technical, financial, and logistical support during the
development of the strategic plan
ii
II. Executive Summary
The Rwanda One Health National Strategic Plan (ROHSP) is a result of the work done by the
One Health Steering committee (OHSC). The OHSCestablished in 2011 has conducted a multi-
actors, multi-sectoral and multi-disciplinary participatory and consensus building process in
order for the government of Rwanda to tackle human, animal and plant health related complex
problems using an integrative and comprehensive institutional, legislative and technical
framework.
In sub-Saharan Africa, Rwanda has the highest human density population and sharing a border
with countries where diseases such as Ebola, Marburg have been declared. Therefore Rwanda is
at risk, furthermore, at the national level, the pressure of human activities at environment-animal
and human interface creates complex problems and favorable conditions for sparking off animal
(domestic and wildlife), human and plants emerging and re-emerging infectious diseases and
other environmental or health related challenges. This situation is not unique to Rwanda as has
been shown with pandemic highly pathogenic avian influenza H5N1 (HPAI H5N1) originating
from the wild birds and its spread around the world due to the socio-economic factors. The main
lesson learnt from the last two decades regarding the emerging and re-emerging infectious
diseases has spotlighted the need to adopt a multi-sectoral, multi-discipline, integrative approach
at local, national and global level to prevent and control emerging and re-emerging infectious
diseases in order to attain optimal health for people, animals and the environment. This approach
or collaborative effort is One Health.
In regard to the One Health approach, a situational analysis was carried out to assess institutional
collaboration on zoonotic disease surveillance, outbreak investigation and response and
conducted interviews to ascertain whether One Health is integrated in the curricula for the
schools of public health and veterinary medicine.
Main findings of the situational analysis revealed that:
• There is lack of collaboration within and between institutions on zoonotic disease
surveillance, outbreak investigation and response
• The capacity of laboratories (human and animal) to confirm priority diseases is still weak
and needs improvement.
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• Political will, capacity and infrastructure necessary to support collaboration between the
animal and human health sectors exist although there is need for a coordination
mechanism that provides a framework for developing collaborations
• There is presence of an electronic surveillance reporting system for both human and
animal health that can be leveraged on to make a joint surveillance system.
The five-year One Health strategic plan will address the gaps identified through the situational
analysis. The vision and mission of the strategic plan are aligned to vision 2020. The goals of
this strategy are to:
i. Promote and strengthen interdisciplinary collaboration and partnerships in One Health
approach
ii. Strengthen surveillance, early detection, rapid response, prevention and control of
zoonosis within the One Health approach and to;
iii. Build capacity and promote applied research at the human-animal-ecosystem interface
At the end of successful implementation of this Strategic Plan, it is expected that;
• One Health will be included in all existing policies and strategic documents of all the key
stakeholder ministries
• One Health Communication strategy will be in place and active.
• A comprehensive system and protocol for the surveillance of epidemic/epizootic
detection, diagnosis, and rapid response will be in place.
• Existing electronic surveillance systems (eIDSR, IMPACT, GAINS) will be maintained,
upgraded and adapted to ensure their inter-operability
• One Health competencies will be well Integrated into relevant academic disciplines and
training programs
The One Health Steering Committee (OHSC) will assume the overall coordination and
oversight regarding the implementation of this strategy.The steering committee will be composed
of representatives from government institutions, bilateral and multilateral partners, Civil Society
Organizations (CSOs), the private sector and communities (CBOs), involved in One Health. It
will be responsible for the overall governance including establishing strategies prioritizing
funding allocationsand advocating and mobilizing resources for one health. Technical aspects of
program implementation will be fully integrated into the appropriate operating units of key
implementing partners through the annual action plans. The Single Project Implementation Unit
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(SPIU) will be the lead office which will coordinate and monitor implementation of project
activities at the national level
The social cluster shall be responsible for providing policy guidance and reviewing and
approving annual action plans and evaluation reports submitted by the steering committee. .
.
v
III. Table of Abbreviations and Acronyms
AHI Animal Human Interface
ARMV Veterinary Association of Rwanda
BRC Biological Resource Center
CCC Country Coordinating Committee
CDC US Centers for Disease Control and Prevention
EID Emerging Infectious Diseases
EHIA Environmental Health Impact Assessment
FELTP Field Epidemiology and Laboratory Program
GCC Global Climatic Change
HPAI Highly Pathogenic Avian Influenza
IMRO IhorereMunyaRwandaOrganisation
INAP Influenza Network Action Plan
KHI Kigali Health Institute
MDGs Millenium Development Goals
MINAGRI Ministry of Agriculture
MINIRENA Ministry of Natural Resources
MINEDUC Ministry of Education
MoH Ministry of Health
NRL National Reference Laboratory
OHCEA One Health for Central and East Africa
RAB Rwanda Agricultural Board
RBC Rwanda Bio-medical Center
RDB Rwanda Development Board
REMA Rwanda Environment and Management Authority
ToR Terms of Reference
UP Umutara Polytechnic
UR University of Rwanda
WHO World Health Organization
vi
IV. List of Institutions that participated in the Strategic Plan
1. Ministry of Health
- Environment and Hygiene Desk
- Community Health Desk
2. Ministry of Agriculture and Animal Resources
3. Ministry of Education
4. Rwanda Biomedical Center
- Epidemic Infectious Diseases Division
- National Reference Laboratory
5. Rwanda Agricultural Board
6. Rwanda Development Board
7. Rwanda Environment Management Authority
8. University of Rwanda
- College of Medicine and Health Sciences
- College of Agriculture,Animal Sciences and Veterinary Medicine
9. USAID
- Country Office
- USAID Grantee - Respond Project
- USAID Grantee - Predict Project
10. One Health Central and East Africa (OHCEA)
11. US Centers for Disease Control and Prevention(CDC)
12. World Health Organization (WHO)
13. Food and Agricultural Organization (FAO)
14. Rwanda Veterinary Association and Council
15. IhorereMunyaRwandaOrganisation -(IMRO)
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V. List of documents used (see references)
1. A Strategic Framework for Reducing Risks of Infectious Diseases at the Animal–Human–
Ecosystems Interface
2. Standard Operating Procedures for Rabies in Rwanda
3. OIE Terrestrial Animal Health Code
4. Economic Development And Poverty Reduction Strategy (EDPRS) II
5. Rwanda Green Growth Strategy
6. Strategic Plan for the Transformation of Agriculture in Rwanda – Phase II (PSTA II)
7. Rwanda State of the Environment and Outlook
8. Rwanda Health Sector Strategic Plan (HSSP) III
9. Environment Sub-Sector Strategic Plan
10. Rwanda Office of Tourism and National Parks Strategic Plan 2009-2015
11. A Strategic Framework for Reducing Risks of Infectious Diseases at the Animal–Human–
Ecosystems Interface - One World One Health
12. One Health Central And Eastern Africa (OHCEA) Ten-Year Strategic Plan
13. Vision 2020
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1. Introduction
1.1 Context and rationale
Mankind is currently facing many challenges, which will require global solutions. One of
these challenges is the spread of infectious diseases that emergea or re-emergeb at the
interfaces between animals and humans and the ecosystems in which they live. This situation
is a result of several factors, including the exponential growth in human and livestock
populations, rapid urbanization, rapidly changing farming systems, closer integration
between livestock and wildlife, forest encroachment, changes in ecosystems and
globalization of trade in animal and animal products.
The most important factor is undoubtedly the dramatic increase in the world’s population,
which is expected to reach 8 billion by 20251 , mainly in Asia, Africa and Latin America,
where most of the world’s poor live. This worldwide population growth, migration patterns,
and environmental degradation have transformed the environment in which human and
animal populations cohabitate, greatly affecting the emergence of infectious and non-
infectious disease trends(2-5).
Rwanda as one of the most densely populated countries in the world with a high human
population density and fast growing population, is prone to these public health threats and
related economic losses. It is therefore the responsibility of the state to ensure that such
disasters do not happen
It is estimated that the cost of SARS for example, based on near-term expenditures and losses
in key sectors such as medical expenses, travel and related services, consumer confidence,
and investment was close to $80 billion6. To tackle these challenges, there is need for a
comprehensive, proactive approach that draws on a wide array of technical and financial
resources.
Evidence suggests that successful prevention and control of these challenges requires a new
One Health approach where collaborative effort of multiple disciplines work locally,
nationally, and globally – to attain optimal health for people, animals and the
environment”7. This One Health approach has gained international attention as an approach
to control infectious disease outbreaks and to address interconnected health threats affecting
animal, human, and ecosystem domains. It promotes a whole of societyapproach by
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incorporating human medicine, veterinary medicine, public health, and environmental
information when developing policy and determining interventions to address current
challenges threatening today’s globalized world. Rwanda as a country is very keen to protect
her citizens and this is very clear in the constitution especially in its Articles 42 and 45; “All
citizens have rights and duties relating to health. The State has the duty of mobilizing the
population for activities aimed at promoting good health and to assist in the implementation
of these activities. All citizens have the right of equal access to public service in accordance
with their competence and abilities". These rights are translated by the VISION 2020 (a key
socio‐economic policy document on which all national and sectoral policies and strategies are
based and on the basis of which the allocation of resources between the various sectors is
made) into a development path, presenting the country’s key priorities aiming at making
Rwanda a middle income country by the year 20201. Through 6 pillars and 3 cross cutting
issues, VISION 2020 puts its people squarely at the centre of its short, medium and long term
plans. The health paragraph of VISION 2020 focuses on the high population growth rate
(3.2%/yr), maternal health, Malaria and HIV/AIDS. In the same spirit of trying to improve
health and economic wellbeing of Rwandans, the government of Rwanda put out the
Economic Development and Poverty Reduction Strategy(EDPRS II) 8 which provides a
medium-term framework for achieving Rwanda’s long-term aspirations as embodied in
VISION 2020. These local policies and strategies use some international policies and
declarations for guidance [the Millennium Development Goals (MDG), the Abuja
Declaration, the African Health Strategy (2007-2015), the Paris Declaration (2005) and the
Accra Agenda for Action (2008), the last two addressing Aid Effectiveness (in particular
Harmonization and Alignment) as a major determinant of effective coordination between all
stakeholders, operating in the sector] as stated in the Health Sector Strategic Plan (HSSP III).
As a country, Rwanda saw the need to develop a framework under which such interventions
at the environment-human-animal interface could be coordinated. In this regard, a One
Health Steering Committeewas created in 2011 and tasked with making One Health a reality.
To achieve this, it was decided that a strategic plan with a clear vision, mission, goals and
objectives would be instrumental in this effect.
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1.2 Zoonotic diseases and one health
Most of the infectious diseases that are naturally transmitted between vertebrate animals and
humans can be transmitted directly by contact with an animal (e.g., rabies), via contaminated
environment (e.g., anthrax), via food (e.g., campylobacteriosis) or indirectly through bites by
arthropod vectors (e.g., Leishmaniasis). The organisms causing zoonoses include viruses,
bacteria, fungi, protozoa and other parasites, with both domestic and wild animals acting as
reservoirs for these pathogens. The diseases they cause in humans range from mild and self-
limiting (e.g., most cases oftoxoplasmosis) to fatal (e.g., Ebola hemorrhagic fever). Evidence
based research has demonstrated that over 60% of human pathogens are of zoonotic origin,
whereas 75% of diseases considered to be emerging or re-emerging are also zoonotic. Over
the last 3 decades, new infectious agents and diseases affecting humans have emerged at a
rate of more than one per year, sometimes resulting in high morbidity and mortality in
humans and animals, and devastating effects on the people, their livelihoods and the national
economies.
Many emerging and existing infectious diseases concern the global community because of
their epidemic and endemic potential and their wide-ranging socioeconomic impacts. New
viruses previously dormant in the environment for decades have started to emerge through a
complex interaction of factors such as habitat destruction, climatic events and the
encroachment of food-animal production into wildlife domains (e.i.Nipah Virus outbreak in
Malaysia, 1999).
There are also many existing infectious diseases to domestic 'food-producing' animals that
cause huge socio-economic impacts. Some of these remain endemic in many developing
countries, where they have been neglected.
1.3 Environment and one health
Diseases of environmental- related cause have also led to tremendous pain and suffering. For
example, most of recent cholera outbreaks have showed how important the environment
breakdown can contribute significantly to the spread of environmental- related diseases. The
speed with which these diseases spread across the increasingly interconnected globe, presents
enormous public health, economic, and development concerns9-10. Therefore the
environment-human-animal interface should be considered together when thinking of
avoiding such catastrophes.
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1.4 Climatic changes and one health
Climate change adds complexity and uncertainty to human health issues such as emerging
infectious diseases, food security, and national sustainability planning that intensify the
importance of interdisciplinary and collaborative research. Collaboration between veterinary,
medical, environment specialists, nurses, anthropologists and public health professionals to
understand the ecological interactions and reactions to flux in a system can facilitate clearer
understanding of climate change impacts on environmental, animal, and human health.
Despite uncertainties surrounding Global Climatic Change (GCC) and ecosystem health,
there are well-recognized disease-associated consequences of weather events. For instance,
temperature driven and hydrology-driven increases in extreme weather events will play out in
several ways. Obvious health-related effects from droughts or floods are immediate trauma,
crop failures, food and water insecurities, and other population stressors.
Not so obvious, however, is the potential for increased human waterborne diseases (e.g.,
Giardiasis and Shigellosis) outside of disasters. For instance, public health data demonstrate
that two-thirds of water borne disease outbreaks occurs after rain events that are among the
top 20% in terms of intensity, most of which do not qualify as disasters11. As extreme
weather events increase in frequency, so too will outbreaks of waterborne diseases among
humans. There is no reason to assume a similar dynamic does not occur among wildlife.
There are current examples of climate-related agent and/or vector incursions to territories or
regions where they are newly endemic. Bluetongue virus, a disease agent among livestock,
was unknown in north of the Mediterranean until recently. Warmer winters allowed its
traditional African/Asian vector, Culicoidesimicola, to become endemic in southern Europe
during the 1990s. The virus then began using indigenous European Culicoides species as
vectors12. Another current example of climate-related disease effects is the incidence of
human disease due to tickborne pathogens has increased as the burden of tick vectors
increased in the wake of GCC. Workers from Sweden have shown that a 20-year increase in
the incidence of tick borne encephalitis among humans is significantly related to changes in
the tick-vector burden during milder winters and earlier arrivals of spring13. It is therefore
important for decision makers to realize that climate is one factor—sometimes a determining
factor—in whether a disease agent or vector expands or contracts its territory of endemicity.
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1.6 Food security, Food safety and One Health
Currently there is a global situation where an estimated 925 million people go hungry. The
effects of food price increases are likely to deepen the vulnerability of those who spend
between 50% and 80% of their family budget on food, mostly basic staples14.
The livestock sector is an area in which One Health thinking and action can make a
difference to lives and livelihoods. Estimates from the World Bank on the projection for the
increase in meat production over the next 40 years indicate that most of this will occur in the
developing world15.
For the 75% of the world’s poor that are rural and dependent on agriculture, disease
outbreaks in livestock not only put at risk their immediate food source, but it also puts at risk
their livelihoods and resilience capacity − and that affects their long-term food security.
Disease outbreaks which reduce the availability of live animals and livestock products can
reduce household income, undermine the diets of household members, impair nutritional
status and increase risks to health, especially of women and children. Outbreaks can also
impair the wider market availability for those products. Chronic food insecurity also drives
risky behaviors related to animals: no one who is well-fed would consider consuming the
carcass of an animal that has died of disease.
Effects of animal disease extend to people who work in production and processing −
including livestock and agri-food workers, transporters and sellers. One Health thinking
helps us find ways to limit these risks and encourage resilient livelihoods.
1.7 Economy and One health
Despite the catastrophic socio-economic consequences of infectious diseases such as malaria
and HIV/AIDS, the impact of epidemics has been considerably under-researched in
economics. Traditionally, studies have attempted to estimate the economic burden of an
epidemic based on the private and non-private medical costs associated with the disease, such
as expenditures on diagnosing and treating the disease. The costs are magnified by the need
to maintain sterile environments, implement prevention measures, and conduct basic
research. The costs of disease also include income forgone as a result of disease-related
morbidity and mortality. Forgone income is normally estimated by the value of workdays lost
due to the illness. In the case of mortality, forgone income is estimated by the capitalized
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value of future lifetime earnings lost to the disease related death, based on projected incomes
for different age groups and age-specific survival rates16.
The 2003 outbreak of SARS infected about 8,000 people in China (including Hong Kong and
Taiwan), Canada, Singapore, and Viet Nam, but cost Asian countries between US$30–50
billion, mostly due to economic repercussions from widespread public fear of the disease17.
Several agencies and experts have attempted to estimate the cost of SARS based on near-
term expenditures and losses in key sectors such as medical expenses, travel and related
services, consumer confidence, and investment. One model estimated that the short-term
global cost of lost economic activity due to SARS was approximately $80 billion however,
the true economic consequences of SARS remain to be determined, particularly given the
possibility of its return.13 If SARS became endemic in the future, it would substantially
increase private and public expenditures on health care and would have more significant
impacts on demographic structure and human capital in the infected economies. Another
alarming scenario is the true cost of the HPAI H5N1. One estimate suggests that a human
influenza pandemic today would cost roughly US$2 trillion 14
1.8 Lessons learned from preparedness and response to Highly Pathogenic avian influenza
H5N1 (HPAI H5N1)
The major lesson learned is the central importance of efficient surveillance, effective
intersectoral collaboration, a well-designed national strategy and sustained political will.
Where any of these elements has been absent or insufficient, countries have been less able to
detect and control the spread of infection, with the result that in some countries the disease
has become entrenched in poultry, thereby increasing the possibility of human infection.
Experience from the Animal Human Interface (AHI) response underscores the importance of
investing in effective disease surveillance at the human, animal and ecosystem levels,
enabling countries to respond to a range of existing and emerging infectious diseases.
In supporting the global effort to control HPAI H5N1, the focus has been on countries
developing their own Influenza Network Action Plan (INAP), with clearly defined roles and
responsibilities for the various sectors and stakeholders. This approach has enabled better
coordination of donor support and has avoided duplication of efforts. The country focus has
also contributed significantly to the development of essential capacity, particularly in the
areas of the much-neglected and underfunded public and animal health sectors. The emphasis
7
on country leadership has been further boosted by the provision of critical support and
guidance by the technical agencies. A shared strategy at the national level has also enabled
better monitoring and evaluation of the plan, resulting in regular refinement of the national
strategy according to changing circumstances. This underscores not only the important
overall improvements made by many countries in successfully implementing their national
plan, but also indicates that the emphasis is shifting away from a crisis response to a focus on
building systems and capacity that can respond effectively to future outbreaks of AHI and
other infectious diseases. The transition away from short-term responses towards more
sustainable capacity and systems strengthening shows the potential utility of consolidating
and broadening this approach to focus on all infectious diseases at the animal–human–
ecosystems interface.
Communication activities are a central crosscutting element of any national strategy. Where
communications strategies have been most effective, they have brought those working in
both animal and human health together with NGOs and civil society to develop
comprehensive and consistent campaigns that target messages to critical audiences. Although
most communications strategies have focused on the short-term objectives of raising
awareness of the AHI threat and on measures to reduce the risk of infection, there is already
evidence of behavior change in some operations. Recognizing the multidimensional nature of
HPAI H5N1 and EID, which involves different health domains and socio-economic
dimensions, there is a need for both a wide range of stakeholders and to promote strategic
collaboration and partnerships across various disciplines, sectors, departments, ministries,
institutions and organizations at the country, regional and international levels. Where
collaboration has been most effective, there has been a clearly articulated strategy and respect
for the specific roles and mandates of the partners involved. Facing the imperative to respond
in an emergency, collaboration around compatible functions—such as virus epidemiology,
diagnostics, research, training or communication—has been relatively easy to achieve, but
sustaining this once the immediate threat has subsided poses a significant challenge. The
emergence of significant cross-sectoral partnerships following the recent global HPAI H5N1
crisis is quite encouraging.
1.9. Methodology
8
The methodology used to develop this strategic plan followed a participatory and consultative
approach. The choice of this approach aimed at supporting an inclusive, participatory and
consensus building process among the environment, human and animal health stakeholders in
order to design the One Health national strategy. The planning process was accomplished in the
following way:
• Consensus within the OHSC to have a One Health Strategic Plan for Rwanda and looking for
funds to implement One Health activities
• Clarification of terms of reference of the consultant, client expectation and setting timelines
for specific outputs, followed by hiring of the consultant.
• Review of literature, institutional guidelines, policies, laws and other relevant documents to
get a clear situation of One Health in Rwanda as well as institutional capacities in this regard.
• Consultative meetings between key informants and the consultant to further understand the
current situation, gaps and expectations.
• Consultations with key partners with experience in One Health concepts to get their view of
the prospects of One Health in Rwanda.
• Strategic planning workshops were held with participation of all institutions and partners
implicated in One Health. The institutional analysis was accomplished through a SWOT
analysis.( Ministry of Health (Rwanda Biomedical Center-EID(EID strategic plan 2012-2018
and IDSR technical guidelines) and National reference laboratory), Rwanda Agricultural
Board (Rwanda Animal Health Law and the epidemio surveillance document), Rwanda
Development board (Strategic plan) and Rwanda Environmental Management Authority
(Environment sub-sector strategic plan 2010 - 2015.) were consulted.
1.9.1 Common Grounds to establishing Vision, Mission and Goals
To come up with a clear vision for OH in Rwanda, common grounds for all the key stake holders
were identified through a consensus building process. Once the common grounds were agreed
upon, the vision was able to be developed followed by the mission and strategic goals and
objectives. This common grounds agreed upon were the following,
• Food safety and security
• Healthy environment
• Early detection and prevention of zoonoses
• Improving lives of Rwandese
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• Public Health
• Disease containment
• Reduce morbidity and mortality
2. Situation Analysis
In this chapter we discuss the current situation of each institution that has a role to play in the
preparedness and implementation of OH activities in Rwanda. While reviewing the different
documents, laws, guidelines and policies for each institution, we used some OH principles to
guide our review and eventual analysis. Some of the principles that were used to guide the
review and analysis are the fact that;
- The OH approach attempts to recognize that numerous disciplines across many sectors are
required to solve the complex problems facing public health.
- It recognizes that most significant public health problems cannot be solved using the
epidemiological triangle and can only be solved using a multi-sectoral approach
- One Health takes a holistic approach to address human, animal, and ecosystemc health
- One Health emphasizes multi-sector, trans-disciplinary action across professions to ensure
well-being within human, animal, and ecosystem interfaces
With these principles in mind, we employed a method aimed at having a participatory, inclusive
and consultative approach to develop this strategic plan.
2.1 Ministry of Health
2.1.1 Emerging Infectious Diseases
The Emerging Infectious Diseases division, (EID Division) is one of the organizational units in
the Rwanda Biomedical Center (RBC) under the Ministry of Health and as such has a key cross-
cutting role in the area of surveillance and response. Because of the very nature of infectious
diseases and the interaction between environment, animal health, and human health the EID
Division often has a role to play with other Ministries and organizations including those across
borders. The EID Division has developed a set of core functions to be able to address the
surveillance and response needs of Rwanda presently and in the near future. The core functions
address public health threats and the collaborative and cooperative requirements needed for
surveillance and response nationally and regionally. The EID Division provides services to the
health sector for detecting and responding to emerging and other epidemic and infectious threats.
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Before the creation of the EID Division in 2006, the disease surveillance and response activities
were based in the Department of Epidemiology within the Ministry of Health. In 2011, the EID
Division was restructured to improve the efficiency and effectiveness of early detection,
confirmation and response to leading but largely preventable public health threats in Rwanda.
The main challenges faced by the EID Division are related to the lack of sufficient resources to
achieve its mission and vision. Financial resources are heavily dependent on external sources
although the government of Rwanda has made substantial efforts to support this newly created
division. The EID Division, as other Ministry of Health entities is facing the lack of sufficient
human resources. This is more pronounced at the peripheral level with high turnover
compromising the efforts made by the EID Division to implement and maintain a reliable and
timely surveillance system. The capacity of the laboratory to confirm priority disease is still
weak and needs improvement. The need for multisectoral disease surveillance is becoming more
and more crucial in this era of emerging diseases and the need for regional coordination and
integration of surveillance activities.
Despite the above challenges, the MoH also has opportunities
The Ministry of Health has placed disease surveillance on the health sector agenda. Disease
surveillance was missing in the current Health Sector Strategic Plan III (HSSP II) and steps have
been taken to remedy that. The creation of the EID Division under RBC to coordinate the control
and prevention of all diseases represents a major paradigm shift in the Rwanda disease
surveillance system. To strengthen the public health workforce together with the National
University of Rwanda School of Public Health and the Ministry of Health, the EID Division
manages the Rwanda Field Epidemiology and Laboratory Training Program (FELTP). This
program provides the Government of Rwanda with skilled human resources to manage public
health programs. The FELTP program helps fortify the bridges between clinical and laboratory
surveillance as well as inter-sectoral collaboration. In fact, the FELTP program has brought the
animal and human health together for better prevention and control of diseases in Rwanda.
Partners in the country support the implementation of disease surveillance activities and are open
to provide more resources. The Rwanda health system is well decentralized up to the community
level. In addition the health facility-based reporting system, there a community-based
information system that can be leveraged to support abnormal events that occurred at the
community level. The community health worker network plays an important role in disaster
11
management in collaboration with the district authorities (administrative and disaster
management committee). The EID Division also aims to build the disease surveillance system
using the health information technology infrastructure that the government of Rwanda is putting
in place.
2.1.2. National Reference Laboratory (NRL)
The medical laboratory services have a sound and well established laboratory network
coordinated by the National Reference Laboratory (NRL) Division and continued progress
towards the standardization of laboratory equipment, tests and supplies. In order to have a good
surveillance and response system, a well-equipped laboratory with trained personnel is key. The
NRL being one of the divisions of the RBC works closely with the other divisions especially the
EID to ensure close monitoring and confirmation of outbreaks. For this reason the NRL is part of
the Rapid Response Team which is responsible for responding to disease outbreaks as soon as
possible. It is quite well equipped with capacity to do a lot of tests given the opportunity. In order
to provide timely service to the citizens, the NRL decentralized its services to the district level
with constant monitoring, supervision and guidance. Some of these decentralized services are
satellite labs dedicated to the early detection of cross boarder epidemics and transmissions.
However, despite all that success, a gap in adequacy of qualified human resources and
maintenance of laboratory equipment and supply chain in the laboratory network exists.
The health Centre and district hospital laboratories still lack the basic inputs according to
national medical laboratory norms and standards; 57% gap of qualified laboratory personnel.
Medical laboratory infrastructure is largely a challenge due to shortage of funds and no proper
implementation of guidelines regarding lab infrastructure norms and standards. Equipment
management remains a problem due to lack of skilled personnel, no immediately supply chain of
spare parts and no streamlined mechanism for handling of non-functioning instruments.
Adequacy in quantity and qualification of laboratory personnel is challenging due to the few
medical laboratory schools and staff high turnover. The implementation of the minimum
laboratory test package is affected by the inconsistent demand of tests leading to reagent stock
out, weak inventory control system and supply chain management. Finally, NRL usually ends up
with a heavy workload because of the inefficiency of the satellite labs and also high demand of
services from various clients. Need for closer collaboration at the district level between the lab
12
and the district focal person for IDSR as most of the time the lab is not informed of what is going
on timely.
2.1.3. Environmental Health and Hygiene Desk (EHD):
The EHD at the ministry of health is one of the most important departments of the ministry
because it deals with prevention of diseases at the local level hence curtailing situations that
would be calamities or diseases that would end up at the health facilities. But if prevention is not
given high level support, we shall continue to see overwhelmed health facilities that cannot
handle their workload. It is noteworthy to point out that over 80% of the disease burden in
Rwanda is caused by poor personal, domestic and community hygiene practices. Worse still 90%
of the consultations at health facilities are for diseases that would be preventable by instituting
simple hygienic principles and practices. For example, 66 % of school children have worms and
44% have amoebiasis. This is clearly as a result of inadequate and unhygienic facilities for
excreta disposal, poor management of liquid and solid waste and inadequate practices of hand
washing with soap.
Environmental Health (WASH) is a central component of the millennium development agenda.
Without significant improvements in water and sanitation access and hygiene practices the
Millennium Development Goals (MDGs) related to child mortality, primary education, disease
reduction, and environmental sustainability and poverty eradication will not be achieved. “Safe
drinking water and adequate sanitation are crucial for poverty reduction, crucial for sustainable
development, and crucial for achieving any and every one of the Millennium Development
Goals”15
One health comes at a good and opportune moment because it will help the EHD to foster its
activities. As the definition of OH states, we cannot achieve optimal human health without a
clean and viable environment. We need to promote and instill this thinking not only in the
professional health providers but the people themselves at the community level because this is
their health we are talking about. With support from partners, the EHD was able to develop a
Community Based Environmental Health Promotion Program with the aim of involving the
community to participate in reducing the national disease burden. This is done in collaboration
with the ministry of local government and other players in the community. The EHD also works
closely with other institutions in implementing cross cutting activities such as food safety,
environment education etc.
13
However the EHD also faces challenges in implementing their activities and see OH as a
blessing to them since it will help to break some barriers. The challenges and weakness include;
• Clinical versus Preventive medicine mentality; -In Rwanda, preventive services/ practice
is less emphasized not only in training but also in practice, even at the policy level. As
such we end up with an imbalance between clinical and preventive services. Clinical
medicine is given the priority over prevention when in fact statistics show that if the
prevention component of health is strong, the clinic would not be overwhelmed.
• Because of the above mentality, there is poor support of most activities with a prevention
component in them. Even the way the ministry is structured, it leaves little room for the
EHD to do much. It is just a small desk under the Maternal and Child Health hence not
giving it the opportunity to fulfill its potential.
• There used to be an Environmental Health Impact Assessment (EHIA) together with the
Environmental Impact Assessment EIA) to guide those who had projects that would deal
with land or the environment in general, but the EHIA is no longer a priority. This should
change.
2.2. MINAGRI/ RAB
It is clear from the Ministry of Agriculture and Animal Resource mission that activities with a
OH perspective are well included. The mission of the MINAGRI is: "to initiate, develop and
manage suitable programs of transformation and modernization of agriculture and livestock to
ensure food security. However, the Veterinary Services Division of the Ministry of Agriculture
and Animal Resources, takes the lead in this OH framework of collaboration on behalf of the
ministry. The main functions of the veterinary services most of which have a OH approach, are
to;
• Provide leadership to the disease control activities aimed to diagnosis, prophylaxis,
treatment, control of animal diseases and movement of livestock and livestock products
and provide early warning measures to farmers
• Provide response and control of animal diseases, including zoonosis, and implement
appropriate control strategies for diagnosis, prophylaxis and treatment
• Oversee activities of satellite laboratories so that they can carry out disease surveillance
and control
• Ensure the effective implementation of laws and regulations governing animal health
14
• Plan and coordinate activities of animal disease control, both within the country at the
borders and other internal control posts
• Coordinate interventions in liaison with local authorities before, during and after disease
outbreaks
• Compile and publish animal disease status information for the country, monitoring and
evaluation of service delivery for animal health at the level of beneficiaries
• Plan and organize training for staff and farmers on animal health, evaluate and
coordinate the unit’s staff performance
Whenever necessary, Rwanda Agricultural Board (RAB) takes quick and necessary measures to
curb the spreading of the epidemics.In a case where the likely cause of the spread of the disease
is commerce and transport, RAB gives regular instructions governing the movement, shifting and
transport of livestock. This means that such animals would require a Transfer Authorization
delivery note to move from one place to another. In addition to the above law, an
epidemicsurveillance system was put in place to warrant permanent surveillance of livestock and
other domestic animals. However, even though the Veterinary services under RAB is doing a
good job in regards to prevention, early detection (diagmosis), rapid response, surveillance
control and public health impact of zoonosis,and has strong political support , it still has a lot to
do if it were to provide the needed services efficiently and effectively to its clients who are the
population. Some of the important challenges and weaknesses hindering the Veterinary services
include the fact that;
- Although the law states clearly the establishment of the epizootic fund, it is not yet
active and this (funds) is the biggest challenge because without funds most activities are
put on stand-by or not done at all.
- Stock out of emergency materials and reagents which makes it difficult to detect and
diagnose early diseases of epidemic potential.
- Even though there is collaboration with various institutions such as MoH, REMA and
RDB-conservation in some particular areas, there is still need for strengthening this
collaboration in line with One Health principles.
- Even if the infrastructure for control, detection and diagnosis of zoonosis are in place,
there is need to strengthen its capacity by equipping the labs, adding well trained and
15
motivated staff to do the testing and planning for the control against this diseases but
also for the quality assurance of food stuff of animal origin.
2.3. Rwanda Development Board - Conservation
The Rwanda Development Board (RDB) was put in place by law No. 53/2008 of 2 September
2008. It is a merger of several institutions among which, is the former Rwanda Office of Tourism
and National Parks (ORTPN) which comprised two main divisions (Wild life and Tourism). In
the re-structuring, the Wild life agency became the Directorate for Conservation and it is under
this directorate that the Veterinary unit (Vet unit) falls. The Vet Unit is charged with monitoring
of the protected areas to ensure control of health risks and ensuring the follow up of wild animals
kept illegally and transferring them to sanctuaries. The Vet unit boasts of a Biological Resource
Center (BRC)whose main task is to monitor closely and control risk of infections to park animals
like the Gorillas. The BRC is an important center for the detection and control of epizootics
especially of wild life origin. The unit also has a wild life database from where reports on health
risks of park animals regularly. The unit has developed strategic partnerships. Locally there is
already some MoUs signed between RDB Conservation Directorate and other institutions but
also internationally there are negotiations going on for partnerships with various institutions. The
Vet unit has done a lot of research on wild animals but most notably on gorillas and they have
presented their work to both local and international fora. They have managed to train their staff
about. The unit has trained nearly all its staff and also other health professionals in health
monitoring. Since Wild life visitations (especially gorillas) are among the top priorities of the
country as it brings in a lot of revenue. It is because of this reason, that a Health Contingency
Plan for the mountain Gorillas was put in place. This is a quite detailed document with clear
guidance on how to handle different epizootics, how to handle them, how to report them and who
to report to.
However, despite the above success of the Vet unit, there are still challenges and weakness that
hinder its efficiency. For example,
- The BRC has not been equipped yet to be fully productive. It is currently equipped to about
15% only which seriously affects its capacity to be a center of excellence
- There are no guidelines in place yet for limiting disease transmission between human
population, livestock and wildlife.
16
- There seems to be no general epizootic surveillance system in place though for gorillas, the
contingency plan covers this task.
2.4. Education Sector;
2.4.1. University of Rwanda (formerly Umutara Polytechnic (UP) and School of
PublicHealth)
Umutara Polytechnic is one of the institutions working in partnership with One Health Central
Eastern Africa network (OHCEA) to implement OH. It is the only place where we find the
school of veterinary medicine. It has tried to sensitize university staff and students about the
OH approach and as of now nearly everyone at UP has at least heard of OH. Even the students
have what they called the OH club. The latter is an idea of students from the Veterinary faculty
but they have been successful in selling the idea to and recruiting students from other faculties.
The University top management is also supportive of these OH thinking. A plan to do a market
survey to find out what happens when current students graduate and enter mainstream work force
is being developed. This survey will try to answer questions like 'what challenges do they find
when they start work? Whether their OH thinking and training helps them integrate faster than
their counterparts who are not OH oriented. Through OHCEA, the school has been able to
develop networks and partnerships with other institutions of higher learning and this need to be
leveraged on. As a result of this networking and partnerships, the school has been able to do joint
research work with some academic institutions both within Africa and outside Africa. The school
has also benefitted from this partnerships by getting experienced senior lecturers from partner
institutions within the OH network. Such people would be very difficult to get in the normal
way. At the same time, students have got scholarships for a master’s degree and others got
scholarships for conferences and various short courses with a focus on course design and
teaching OH competencies.
However despite the above successes so far at UP in regard to OH, there are some weakness and
challenges noticed, such as;
Collaboration with other key stakeholders; - UP has no collaboration which is tangible, with
other key players in the OH movement in Rwanda. Though they share the same partner with the
School of Public Health, they rarely share information or meet to discuss some common grounds
apart from when they meet under the auspices of the country steering committee.
17
Sustainability of the program- the programs and activities done at UP are funded by and large
with funds from OHCEA. But after OHCEA goes, there is no clear strategy on how this
programs and activities can be sustainable.
Lack of sensitized Human Resource to advance the OH thinking and competencies; - It needs not
only technical people to know and appreciate the OH approach but rather everyone from policy
makers to funding partners
Communication and regular meetings- There is lack or minimal communication between key
stake holders mainly because the common grounds between stake holders has not been well
defined.
2.5 Rwanda Environment Management Authority
The Rwanda Environment Management Authority is non-sectorial institution mandated to
facilitate coordination and oversight of the implementation of national environmental policy and
the subsequent legislation. It operates under the Ministry of Natural Resources (MINIRENA).
The alarming rate of environmental destruction as a result of population pressure, serious
erosion, pressure on natural resources, massive deforestation, pollution in its various forms etc.
necessitated the Government, to form REMA to coordinate, supervise and regulate
environmental management for sustainable development in Rwanda.
Mandates, roles and functions of REMA are clearly stipulated in Law No 16/2006 of 03/04/2006
REMA has managed to develop guidelines and policies that help them to work more smoothly
with all the various partners because these policies and guidelines are clear and all REMA does
is the awareness and sensitization about them. Some of these guidelines include;
• Strategic Environmental Assessment (SEA) is the process by which environmental
considerations are required to be fully integrated into the preparation of Plans and
Programs and prior to their final adoption. The objectives of the SEA process are to
provide for a high level of protection of the environment and to promote sustainable
development by contributing to the integration of environmental considerations into the
preparation and adoption of specified Plans and Programs.
• Environmental Impact Assessment (EIA) guidelines- Carrying out EIA process enables
implementation of environmental safeguards to mitigate significant impacts caused by
execution of projects which avoids ecological damage and large-scale irreversible loss of
18
natural resources. However, various projects have different level damage or pollution to
the environment depending on their activities, size and products among others.
For the above two guidelines, REMA managed to convince the policy makers to include them in
the Budget Call Circular as annexes. REMA together with the EHD of the MOH, educate both
policy makers and citizens on the different policies but also on the health benefits if the
environment is well preserved. With experience in advocacy and sensitization, REMA is
confident that they can also advocate for and sensitize people on OH especially in regard to
environmental health and together with other stakeholders can map out a strategy of
communication that can benefit OH. Their guiding principle is Article 49 of the constitution that
emphasizes the 'right to a healthy and a clean environment.
However even if REMA seems to be doing well broadly, they also face some challenges that
usually end up hampering the success envisioned. Some of these challenges and weakness are;
• Lack of data caused by the weak system of data collection in the sub sector of
environment is a key challenge. Where data exists, their credibility and quality are
doubtful.
• Poor mainstreaming of environment in other sectors which contribute to environmental
degradation as a result of actions by these sectors
• Weak coordination of the sub-sector activities including collection of data from
stakeholders
• Weak integration of environmental indicators in NISR data collection and analysis
processes.
• Further, coordination mechanisms within the sector and sub-sectors need strengthening to
ensure an inclusive stakeholders participation in the sector.
2.6. Collaboration
The most common and shared weakness among all key institutions was lack of collaboration
within and outside the institutions. Even though we see some collaboration between institutions,
it is mostly on individual basis as by and large there is no institutional link between the key
stakeholders. Taking an example of Zoonotic disease, we see that the key to detecting and
controlling the emergence or re-emergence of zoonoses is a coordinated action on the part of
animal and human health sectors but most of the time it is left to the animal health sector to do it.
19
Indeed, it is crucial to detect and control early any emerging and re-emerging zoonoses at the
animal source to prevent it from infecting human population. Well established and defined
communication procedures (both sides: animal to public sector and public to animal sector) when
outbreaks occur is also crucial for early warning and better control of the disease. Thus it is
critical to establish good collaborations between animal and human health sectors to ensure
synergistic actions, make rational use of available resources, improve efficiency and avoid
duplication of work.
Although inter-sectoral collaborations are in place for avian influenza and there is some good
level of collaboration when it comes to responding to epidemics through formation of Rapid
Response teams, these may not cover other zoonoses or emerging disease epidemics. The
capacity and infrastructure necessary to support collaboration between the animal and human
health sectors exist but there is need for a coordination mechanism that provides a framework for
developing collaborations to address zoonoses and other emerging and re-emerging diseases.
2.7. General Situation Analysis Summary
Strength
• The presence of an electronic surveillance reporting system for both human and animal
health
• Both human and animal health systems are well decentralized up to the community level,
so is the reporting system
• Collaborative activities exist within the human and animal health experts mainly through
the rapid response team and the environment authority also works closely with the two
disciplines in areas where their expertise is needed.
• Both Wildlife and domestic animal sectors as well as the human health sector, have
laboratories that are well equipped to monitor closely and control risk of epidemics,
though the human resource capacity is still low.
• The University of Rwanda has good collaborations with other regional universities and
also with the private sector which makes it easier to exchange information and make sure
graduating students who enter the workforce are One Health oriented.
20
Weaknesses
• The most common and shared weakness among all key institutions was lack of
collaboration within and outside the institutions.
• Lack of well defined communication procedures (both sides: animal to public sector and
public to animal sector) when outbreaks occur.
• Lack of skilled and motivated staff in some key units of institutions. Such units where a
skilled and motivated staff would be very influential is the laboratory (for early detection
and diagnosis of infectious diseases).
• The capacity of laboratories (human and animal) to confirm priority diseases is still weak
and needs improvement.
21
3. One Health Strategic Plan
3.1. Vision
A Rwanda with sustainable health for people, animals and their environment for the well-being
of her population
3.2. Mission
To ensure prevention and control of zoonotic diseases in a healthy environment through multi-
disciplinary collaboration in capacity building, research and community services.
3.3. Goals and Objectives
3.3.1 Goal 1. Promote and strengthen national and regional interdisciplinary collaboration and
partnerships in One Health approach
• A mechanism promoting collaboration between animal (including wildlife) and human
sectors at national and sub-national levels is required for OH approaches to take root in
Rwanda. In addition, the curricula at human and animal health training institutions
should include OH approaches. Through the OHSC, linkages between sub-national
human and animal (including wildlife) health activities will be enhanced and national
policies on OH developed. Communication strategies will also be developed and
implemented to support prevention and response capacities. The human-animal-
ecosystem health linkages are vital for proper understanding and effective management
of endemic and emerging disease threats. This goal will be achieved by pursuing various
activities under four objectives as shown in Table 3.
• Objective 1.1: Establish a national and regional framework for multidisciplinary
collaboration among stakeholders in OH. There has been some progress as described in
Section 1.2.3 above.
• Objective 1.2: Create national awareness for target groups on OH concept.
• Objective 1.3: Ensure networking and information sharing among one health
stakeholders and the fourth objective is to advocate for one health and resources
mobilization
22
3.3.2 Goal 2. Strengthen surveillance, early detection, rapid response, prevention and control of
zoonosis within the one health approach
Surveillance is fundamental to disease prevention and control efforts, including assessment of
effectiveness of the various interventions. The limited resources and capacities typically
available in resource-limited countries necessitate targeted or risk based surveillance that places
additional resources in the areas at high risk of occurrence and spread of disease. To continue
reducing the burden of diseases of zoonotic or environmental origin, there is need to develop and
systematically implement data-driven prevention and control strategies. While medium- to long-
term plans for surveillance systems and capacity building are ongoing, there will be need to
respond to emergencies arising from epidemics/epizotics of known zoonoses and unknown
emerging infections, most of which are also zoonoses. This goal will be achieved by pursuing
various activities under three objectives as shown in Table 3
• Objective 2.1: Promote joint preparedness and response to zoonotic diseases outbreaks.
• Objective 2.2: Strengthen zoonotic diseases surveillance, prevention and control.
• Objective 2.3Strengthen lab capacities to detect zoonotic diseases
3.3.3 Goal 3. Building capacity and promote applied research at the human-animal-ecosystem
interface
For priority zoonotic diseases, much still remains unknown including the sources and drivers of
disease emergence and re-emergence, factors enhancing spread, mechanisms of pathogen
maintenance and persistence including ecology. Reliable risk maps for priority zoonotic diseases
and understanding the socio-economic impact of such diseases on livelihoods and government is
important in targeted and effective prevention and control measures. Public dissemination of
such findings at national and international levels is important. This goal will be achieved by
pursuing various activities under three objectives as shown in Table 3.
Objective 3.1: Promoting OH approach in formal and informal training
Objective 3.2: Promoting applied research at the human-animal-ecosystem. There will be efforts
to identify priority research areas at the human-animal interface, followed by the promotion of
applied research collaboration with human health, animal health, and environmental scientists. In
addition, we will design and implement special studies, such as transmission mechanism or
cross-species sub-typing of etiological agents during epidemics of zoonotic diseases.
23
Objective 3.3: Enhance national, regional and international networking with the scientific
community on zoonotic diseases.
This will be accomplished by holding national and regional scientific workshops targeting
universities and research institutions to present on neglected zoonotic diseases, including training
and mentorship on OH to veterinary, medical, and public health trainees. In addition, we will
promote publication of findings on zoonotic diseases
3.4. Guiding principles
This Strategic Plan is guided by these key principles:
• Prevention and control of Emerging Infectious Diseases (both zoonotic and non-zoonotic)
benefits public health and other public health events and requires strong political and
financial commitment at national and sub-national levels
• For sustainability, utilization of existing institutions and whenever possible, drawing on
lessons learned to refine strategies and interventions
• A multidisciplinary approach is required to realize technical, political, and regulatory
frameworks required to address Emerging Infectious Diseases and other public health
events
• An activity annual plan will be developed for very financial year
• The strategy should be science-based and continually adjust to new information and
technologies and to the changing environment. This means that the Strategic plan is not a
live document that can be updated to meet current standards and incorporate new ideas
whenever possible.
The Strategic Framework must be communicatedadequately so that it is understood by the local
community, especially in the case of incentives.
The Strategic Plan sets priorities for actions and interventions based on a number of criteria that
include feasibility, benefit–cost analysis of different options, financial viability, the types of
impact and long-term sustainability. It gives the OHSC the stage to build on the existing
approaches and mandates of key institutions and other partners to form a flexible network, which
is expected to be flexible enough to be able to adapt, form new coalitions and respond rapidly to
any new health emergencies.
24
3.5. Implementation Framework
3.5.1. Governance and Management
The One Health Strategy is in line with major policy documents including Vision 2020 and the
Rwanda Economic Development And Poverty Reduction Strategy (EDPRS II), the International
Health Regulation, International Animal Health Organization Animal Health Code, Millennium,
Development Goals,This strategy will serve as a guiding document for a collaborative, holistic
and multi-sectoral approach to address complex public health (human, animal and ecosystem
interface) challenges in Rwanda.
A coordination mechanism shall be set up to strengthen synergies and ensure an optimum
participation of all key actors and effective implementation and utilization of the available
resources (human, information, logistics and finance). The one health steering committee will
assume the overall coordination and oversight regarding the implementation of this strategy.
The One Health Steering Committee is composed of all key stakeholders in Rwanda
responsible for the implementation of the OH strategy in Rwanda. The steering committee will
be composed of representatives from government institutions, bilateral and multilateral partners,
Civil Society Organizations (CSOs), the private sector and communities (CBOs), involved in one
health. It will be responsible for the overall governance including establishing strategies,
prioritizing funding allocations, and advocating and mobilizing resources for one health.
Technical aspects of program implementation will be fully integrated into the appropriate
operating units of key implementing partners through the annual action plans. The Single Project
Implementation Unit (SPIU) will be the lead office which will coordinate and monitor
implementation of project activities at the national level (see Figure 1 – Rwanda OH
Organizational chart)
The implementation arrangements will be as follows: (i) annual work plans will be prepared by
the One Health country steering committee by working closely with other key stakeholders; (ii)
A program manager, accountant and M&E officer within SPIU will review the plans and prepare
consolidated annual work plans of all activities; (iii) National Steering Committees under the
overall guidance of the Social Cluster will review and approve the consolidated plans; (iv)
Consolidated plans will be submitted to the Social Cluster on an annual basis for review and
approval.
25
Figure 1: Rwanda OH Organizational chart
Social Cluster - Level of
Ministers
- Level of PS
SPIU
Steering
Committee
Implementing
Institution Implementing
Institution Implementing
Institution
Implementing
Institution
Implementing
Institution
Prime
Minister's
office
26
3.5.2. Strategy and Partnership
An approach to diseases at the animal–human–ecosystems interface calls for new working
relations among existing institutions. Effort will be made to develop meaningful and productive
institutional partnerships among the traditional public, animal (domestic, wildlife), environment
health and education sectors, and also among social and public financing sectors, and also
promote the public private partnership.
Contingency planning and action will be achieved through a regulatory instrument (policy)
and/or less formal mechanisms such as a memorandum of agreement. Set-ups will be adapted to
varying needs during an outbreak or inter-epidemic or inter-pandemic periods. This strategic
plan will be implemented under the spirit of One Health, recognizing the importance of inter-
sectoral, multi-sectoral and cross boarder collaboration; and the fact that all available resources
are essential in its success. The steering committee shall meet on a quarterly basis to review
progress in the implementation of the strategic plan, discuss challenges and recommend remedial
measures. Note that the leadership should be rotative.
3.5.3. Resources mobilization
One health steering committee will provide an oversight of resources mobilization and will set
priorities with regards to the availability of resources.
A common basket approach will be envisaged in view of pooling together all resources
earmarked for supporting the implementation of the one health approach. Therefore, partners and
stakeholders willing to support activities under this strategic plan will use this mechanism for
smooth implementation.
3.5.4. Monitoring and evaluation
Monitoring and evaluation will be an important aspect of this strategic plan. It shall provide the
mechanisms for monitoring, reviewing, and evaluating progress towards the realization of One
Health. The implementation of this plan will be evaluated against the performance indicators. It
is imperative to elaborate a comprehensive and detailed annual action plan from which a
monitoring framework will be established. The main sources of data for monitoring, review and
evaluation of the strategic plan will be from progress reports from the sub-recipients The SPIU
will be responsible for fiduciary aspects and preparing quarterly and annual consolidated
technical and financial reportsthat will be submitted to the permanent secretaries of
implementing institutions prior to submission to the social cluster.
27
Evaluation of the plan will serve two main purposes; first, to enquire into the feasibility of the
plan and second, to assess the overall impact. Evaluation of the strategic plan will be useful in
several ways; first, to avoid the possibility of wasting resources by aiding the selection of the
most effective options. Second, it will help steering committee to continue with the plan that is
likely to produce the intended results and lastly, it will detect and correct some of the factors that
may reduce the positive impact of One Health implementation.
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3.6. Strategic Logic framework (objectives, actions, indicators)
Goals Objectives Activities Sub-activities Indicator
Promote and
strengthen
interdisciplinary
collaboration and
partnerships in One
Health approach
1. Establish a
framework for
multi-disciplinary
collaboration
among
stakeholders in
OH
1.1.Integrate OH concept
into current/existing
institutional policy
documents
1.1.1: Organize meetings to present
proposed policy statements to
implementing institutions for
approval and integration.
Policy statements integrated
in different institutional
policies and reflected in
action plans
1.2. Institutionalize and
operationalize One Health
implementation framework
1.2.1: Develop ToR of Program
Manager, M&E Officer and
accountant
Job description of staff
available by mid March 2014
1.2.2 Recruit required staff Contracts signed
1.2.3: Equip staff with appropriate
office material
necessary office material
available and installed
1.2.4: Develop ToR for the OH
focal person at institutional level
ToF of OH focal person
adopted by concerned
institutions
1.2.5: Monitor and Evaluate OH M&E Reports
29
Strategy
1.3Advocate for
implementation of One
Health concept at regional
economic blocs
1.3.1: Develop a concept note on
regional approach to implementing
OH (to be tabled during the EAC
annual ministerial meeting)
Concept note validated at
national level (Social
Cluster)
1.3.2: Validate the concept note by
the Steering Committee and
Ministers
One Health concept
presented at the councils of
regional economic blocs
2. Create national
awareness for
target groups
around OH
concept
2.1 Advocate for inclusion
for OH competencies in the
curricula of public and
private academic institutions
2.1.1: Develop OH communication
strategy
Document defining
communication strategy
adopted and available
2.1.2: Organize advocacy meetings
with Deans, Principles of schools
and Rectors.
Advocacy meeting report
2.1.3: Organize a OH public talk
and also exhibit materials of OH in
different schools.
No. of meetings held, public
talk and exhibition
conducted
30
2.2. Increase awareness of
the OH concept in high
learning institutions and
secondary schools (school of
tourism, forestry, veterinary
schools, nursing, health
administration, etc.)
2.2.1: Organize meeting with
Directors of schools.
Meeting reports
2.2.2: Develop awareness materials
(film, posters, newsletter,
articles…)
Number and type of
awareness material
developed, distributed
2.2.3: Organize a OH public talk
and also exhibit materials of OH in
different schools.
No. of secondary schools
where OH public talk
organized
2.2.4: Support creation of OH clubs
in schools
No. of functional OH clubs
2.3.Increase awareness to
decentralized decision
makers in all sectors
(animal, human, and
environmental sectors) on
the OH approach.
2.3.1: Conduct a baseline
assessment on knowledge, attitude
and practices on OH
Report on findings of the
baseline survey
2.3.2: Organize meeting with local
authorities.
Meeting reports
2.3.3: Develop and disseminate
awareness materials (film, posters,
newsletter, articles…).
Number and type of
awareness material
developed, distributed
31
2.3.4. Organize adverts, radio and
TV talk shows periodically
Number and type of adverts
broadcast,
3. Ensure
networking and
information
sharing among
OH stakeholders
3.1.Increase awareness to
decentralized decision
makers in all sectors
(animal, human, and
environmental sectors) on
the OH approach
3.1.1: Organize quarterly SC
meetings
No of meetings held
3.1.2: Establish multi-sectoral
emergency response center
Operational multi-
sectoralreponse center
3.1.3: Create and maintain OH
website
A dynamic website for OH
in Rwanda active
3.1.4: Convene a semestrial
stakeholders' symposium on One
Health
No of stakeholders
symposium report available
3.1.5: Develop and publish OH
newsletter
No. of news letters published
4.Mobilization
resource for OH
4.1. Advocate for funding
from partner institutions.
4.2.1: Share the OH SP with
partners for future funding
No. of partners who received
the SP
4.2.2: Organize annual fundraising
meetings
Report of the fundraising
outcomes
32
4.2.3: Identify and apply for new
funding opportunities/grants
No. of grant applications
submitted
Strengthen
surveillance,
prevention, early
detection, rapid
response and control
of zoonoses in both
humans and animals
and other public
health events
1. To promote
joint preparedness
and response to
zoonotic diseases
outbreaks and
other public
health events
1.1 Develop an integrated
approach for monitoring,
collection, management,
analysis and dissemination
of data on zoonoses and
other public health events
1.1.1: Workshop to review and
adapt existing surveillance
guidelines and other surveillance
technical documents to
emerging/re-emerging zoonotic
diseases and other public health
threats
Workshop report
1.1.2: Production and distribution
of reviewed and adapted
surveillance technical documents to
emerging/re-emerging zoonotic
diseases and other public health
threats
No. of reviewed and adapted
surveillance technical
document produced and
distributed
1.1.3: Organize quarterly meetings
for sharing information on
surveillance activities in human,
livestock, wildlife and environment
interface
No. of meeting
minutesavailable
33
1.1.4: Disseminate findings from
each sectoral surveillance system
through quarterly OH bulletin
No. of OH bulletins
produced and disseminated
1.2. Establish a
comprehensive system and
protocol for the surveillance
of diseases in wildlife within
the protected and non-
protected areas
1.2.1: Conduct baseline assessment
to identify non-primate wildlife and
related diseases for surveillance
system within protected areas
Baseline assessment report
available
1.2.2: Develop a harmonized
surveillance technical guideline for
One Health priority wildlife
diseases
Document on technical
wildlife surveillance for OH
priority diseases
1.2.3: Establish a support system
for epidemiological data collection
system
No. of collection, analysis
and storage materials availed
1.2.4: Upgrade the existing
laboratory capacity for surveillance
of One Health priority wildlife
diseases
Report on establishment of
interconnectivity of existing
wildlife surveillance systems
1.2.5: Recruit staff to support
disease surveillance of wildlife
No. of staff recruited for
34
within the protected areas of the
country
every national park
1.3. Develop contingency
plans for potential zoonotic
disease and other public
health threats
1.3.1: Organize workshops for
elaboration and validation of
specific contingency plans
No. of OH interest disease
with contingency plan
1.3.2: Organize Internal and cross
boarder simulation exercises to
improve operationalization of the
validated contingency plans
No. of Internal and cross
boarder simulation exercises
conducted
2. To strengthen
zoonotic diseases
and other public
health events
surveillance,
early detection,
prevention and
control
2.1.Support existing
surveillance systems within
OH member institutions
2.1.1.Extend the existing gorilla
surveillance system to other
selected primates
Report of extension of gorilla
surveillance system to other
selected primates
2.1.2.Maintain, upgrade and adapt
the existing electronic surveillance
system (eIDSR, IMPACT, GAINS)
and ensure their inter-operability
reports on maintenance,
system upgrade and inter
operability among existing
systems
2.1.3.Establish electronic
surveillance system for livestock
Report on establishment of
electronic surveillance
35
diseases and unsure interoperability
with other systems in spirit of OH
system for livestock
2.1.4. Support payment of PBF
(Performance Based Financing) for
OH appointed staff
No. of PBF supported staff
2.1.5. Purchase office materials list of office material
purchased
2.2.Support shipment
of laboratory samples at
national and international
levels
2.2.1.Facilitate national sample
transportation from peripheral to
National Reference Laboratories
# of samples shipped from
from peripheral to National
Reference Laboratories
2.2.2.Facilitate shipment of samples
to regional/ international
laboratories
# samples shipped to
regional/ international
laboratories
2.2.3 Procure specific materials for
specimen collection and shipment
list of specific materials for
specimen collection and
shipment procured
36
2.2.4.Procure 5 appropriate vehicles
for proper bio-containment and safe
transportation between peripheral
and central labs
number of appropriate
vehicles for proper bio-
containment and safe
transportation of samples
procured
2.3. Strengthen the
implementation of joint
prevention and control
strategies for zoonotic
diseases and other public
health events
2.3.1.Organize workshops for
review and development of
standard operating procedures
(SOPs) for pre-analytical, analytical
and post-analytical activities
Workshop report
2.3.2.Procure specific materials for
prevention and control measures of
zoonotic diseases and other public
health threats
List of procured materials
2.4.Implement OH plans for
jointly responding to
epizootics and other public
health threats
2.4.1.Conduct joint outbreak
investigation
report on investigation
2.4.2.Conduct joint outbreak
response and management
evaluation
report of evaluation
37
2.4.3 Procure specific materials for
case management of zoonotic
diseases and other public health
threats
list of case management
specific materials procured
2.5. Develop and implement
a training plan for zoonotic
disease and other public
health threats surveillance
personnel
2.5.1.Organize joint TOT on
zoonotic diseases and other public
health threats surveillance
personnel at central level
No. of personnel trained
2.5.2.Organize TOT on zoonotic
diseases and other public health
threats for surveillance personnel at
district level
No. of personnel trained
2.5.3.Organize training on zoonotic
diseases and other public health
threats for surveillance personnel at
sector level
No. of personnel trained
2.5.4.Participate in regional and
international short courses on
zoonotic diseases and other public
health threats for surveillance
No. of personnel trained
38
personnel at national level
3. Strengthen lab
capacities to
detect zoonotic
diseases 3.1. Evaluate and map out
laboratory capacities and
resources in each sector for
detection of zoonotic
diseases and other public
health events. Identify gaps
3.1.1: Conduct assessment of
laboratory capacities in existing
Human, Animal and Wildlife
central laboratories for detection of
priority zoonotic disease
Assessment findings report
available
3.1.2: Organize workshop to review
findings and prioritize capacities to
improve based on available
resources
Workshop reports
3.2. Establish linkage of
laboratory networks between
human and animal sectors
3.2.1: Conduct a workshop to
develop a framework for
collaboration and laboratory
capacity
No. of workshop conducted
3.2.2: Conduct quarterly meetings
to share regular updates between
laboratories
Meeting reports
3.3. Enhance existing lab
capability to diagnose
3.3.1: Upgrade the lab biosafety
level to handle priority zoonotic
No. of Laboratory with
upgraded biosafety level
39
specific zoonotic diseases
and other public health
events
diseases
3.3.2: Procure laboratory
equipment
Inventory of equipment
procured
3.3.3: Procure reagents and
consumables
Inventory of reagents and
consumables procured
3.3.4: Recruit staff to support lab
activities
No. of staff recruited
3.3.5: Implement equipment
maintenance and calibration
services
Registerof maintenance and
calibration of equipment
3.3.6: Identify and participate in
external quality assessment
schemes (EQAS) for tested
zoonotic diseases
No. of tests performed with
EQAS
3.4 Develop and implement
a training plan for laboratory
personnel in zoonotic
disease pathogens
3.4.1: Organize workshops on
Laboratory Quality Management
System and ISO 15189 Lab
Accreditation
Minutes of joint meetings
within the network
3.4.2: Training lab personnel (i.e. No. of personnel trained per
40
Virologists, Microbiologists,
Pathologists, Entomologists/
Parasitologists)
lab speciality
3.4.3: Conduct in-service training
to improve skills and knowledge of
lab staff on zoonotic diseases
No. of personnel trained per
in-service training
3.5. Identify and establish
cooperation with regional
and international reference
laboratories for human and
animal diseases and other
public health events
3.5.1: Identify and contact regional
and international reference
laboratories to collaborate for
needed capacities not available in-
country for human and animal
diseases and other public health
events
List of regional and/or
international labs contacted
41
3.5.2: Establish legal collaboration
framework and partnership with
identified regional and international
reference laboratories to build
and/or support capacity to provide
needed lab services
No. of regional and/or
international labs with
formal collaboration
framework
Build capacity and
promote applied
research at the human-
animal-ecosystem
interface
1. Promote OH
approach in
formal and
informal training
1.1.Integrate OH
competencies into relevant
academic disciplines and
training programs
1.1.1.Develop the OH core
competencies across undergraduate,
graduate and post graduate stages
of education
1.1.2: Develop implementation
plans for the integration of OH
competencies into curricula
1.1.3: Develop learning tools to
assist with implementation
Inventory of learning tools
available
1.1.4: Conduct interdisciplinary
faculty development workshops to
advance OH knowledge and
teaching skills
Workshop report available
42
1.2.Promote and develop
integrated advanced training
opportunities to mentor and
develop future leaders in OH
education, research and
implementation
1.2.1: Conduct an asset-based need
assessment to identify existing
training models and resources
Assessment report available
1.2.2: Expand and promote existing
integrated advanced training
opportunities (short and long tern
FELTP, OH demonstration site, OH
field attachment, OH leadership,...)
to mentor and develop future
leaders in OH education, research
and implementation
Training reports available
1.2.3: Develop and implement
integrated advanced training
opportunities to mentor and
develop future leaders in OH
education, research and
implementation
Training reports available
1.3.Establish faculty and
trainees exchanges and
1.3.1: Establish a "OH community"
to link and inform scholars, trainees
OH community management
43
collaboration across the
OHCEA network and
beyond
and implementers on opportunities
for exchanges and collaboration
report available
1.3.2:Create incentives to promote
exchanges and collaboration across
OHCEA network and beyond
Number of
people/Institutions receiving
incentives
2. Promote
applied research
at the human-
animal-ecosystem
interface..
2.1 Identify priority health
concerns at the interface
2.1.1: Identify and prioritize health
concerns that are amenable to
intervention
2.2.Identify and promote
applied research at the
human, animal and
ecosystem interface
2.2.1: Using health concerns
identified above, develop and
implement applied research
agendas to benefit the health of
Rwanda
Research Agenda available
Interim and final progress
reports available
2.2.2: Design and implement
research to address existing or
anticipated zoonotic epidemics or
other public health events at the
human, animal and ecosystem
interface
Number of research protocol
available
Number of findings reports
shared with stakeholders
2.2.3: Create incentives to Number of incentives
44
encourage collaborative applied
research
awarded
3. Enhance
national, regional
and international
networking with
the scientific
community on
health concerns at
human, animal
and ecosystem
interface
3.1.Hold national, regional
and international
workshops, conferences on
health concerns at human,
animal and ecosystem
interface
3.1.1: Organize national quarterly
OH grand rounds
Quarterly grand rounds
reports available
3.1.2: Organize international OH
conference every two year
Conference report available
3.1.3: Advocate for inclusion of OH
theme into existing associations,
fora and conferences
Number of conferences, fora
and associations including
OH theme
3.2.Promote writing and
publication of abstracts and
manuscripts on health
concerns at the human,
animal and ecosystem
interface
3.2.1: Support participation in
national,
regional and international
conferences addressing
health concerns at human, animal
and ecosystem
interface
Number of people
participating in such
conferences
45
3.2.2: Organize manuscript/abstract
writing workshops
Training report available
3.2.3: Provide financial support to
subscribe and submit manuscript to
peer-review journals
Number of papers submitted
Number of peer-reviewed
Journals subscribed
3.7. Budget (in RWF)
46
Activity Sub-Activity Indicator of
progress
Target Budget Total (RWF) Source of Funds
Yr
1
Yr
2
Yr
3
Yr
4 Yr 5
A B C D
Goals 1: Promote and strengthen interdisciplinary collaboration and partnerships in One Health approach at national, regional and international level
Strategies 1.1: Establish a framework for multi-disciplinary collaboration among stakeholders in OH
Activity 1.1.1: Integrate OH
concept into current/existing
institutional policy documents
1.1.1.1: Organize meetings to present
proposed policy statements to
implementing institutions for approval
and integration.
Policy statements
integrated in
different
institutional
policies and
reflected in action
plans
X
196,000.00
Activity 1.1.2: Institutionalize
and operationalize One
Health implementation
framework
1.1.2.1 Develop ToR of Program
Manager, M&E Officer and accountant
Draft document
available by mid
March 2014 X -
1.1.2.2: Recruit and employ required staff Contracts signed
and physical
address of the OH
office
X X X X X
195,000,000.00
1.1.2.4 Equip staff with appropriate office
material
necessary office
material available
and installed X 13,706,750.00
1.1.2.5 Develop ToR for the OH focal
person at institutional level
ToF of OH focal
person adopted by
concerned
institutions
X -
1.1.2.6 Monitor and Evaluate OH
Strategy
M&E Reports X X X X X
Activity 1.1.3: Advocate for
implementation of One
Health concept at regional
economic blocs
1.1.3.1: Develop a concept note on
regional approach to implementing OH
(to be tabled during the EAC annual
ministerial meeting)
Concept note
validated at
national level
(Social Cluster)
X -
47
1.1.3.2: Validate the concept note by the
Steering Committee and Ministers
One Health
concept presented
at the councils of
regional economic
blocs
X -
Strategy 1.2: Create national awareness for target groups around OH concept
Activity 1.2.1: Advocate for
inclusion for OH
competencies in the curricula
of public and private
academic institutions
1.2.1.1: Develop OH communication
strategy
Document defining
communication
strategy adopted
and available
X 412,000.00
1.2.1.2: Organize advocacy meetings with
Deans, Principles of schools and Rectors.
Advocacy meeting
report X
1,708,000.00
1.2.1.3: Organize a OH public talk
(conference) and also exhibit materials of
OH in different high schools.
# of meetings held,
public talk and
exhibition
conducted
X X
4,324,000.00
Activity 1.2.2: Increase
awareness of the OH concept
in high learning institutions
and secondary schools
(school of tourism, forestry,
veterinary schools, nursing,
health administration, etc.)
1.2.2.1: Organize meeting with Directors
of schools.
Meeting reports X 1,676,200.00
1.2.2.2: Develop awareness materials
(film, posters, news letter, articles…)
Number and type
of awareness
material
developed,
distributed
X X X X X
170,800,000.00
1.2.2.3: Organize a OH public talk and
also exhibit materials of OH in different
secondary schools.
# of secondary
schools where OH
public talk
organized
X X X X X
136,750,000.00
1.2.2.4: Support creation of OH clubs in
schools
# of functional OH
clubs X X 12,300,000.00
Activity 1.2.3: Increase
awareness to decentralized
decision makers in all sectors
1.2.3.1: Conduct a baseline assessment
on knowledge, attitude and practices on
OH
Report on findings
of the baseline
survey X 80,840,000.00
48
(animal, human, and
environmental sectors) on the
OH approach
1.2.3.2: Organize meeting with local
authorities.
Meeting reports X
3,736,000.00
1.2.3.3: Develop and disseminate
awareness materials (film, posters, news
letter, articles…).
Number and type
of awareness
material
developed,
distributed
X X X X X
170,800,000.00
1.2.3.4 Organize adverts, radio and TV
talk shows periodically
Number and type
of adverts
broadcast, X X X X X
4,500,000.00
Strategy 1.3: Ensure networking and information sharing among OH stakeholders
Activity 1.3.1: Ensure
coordination of steering
committee
1.3.1.1 Organize quarterly SC meetings No of meetings
held X X X X X
3,600,000.00
1.3.1.2 Establish multi-sectoral
emergency response center
Operational multi-
sectoral response
center X 11,500,000.00
1.3.1.3: Create and maintain OH website A dynamic website
for OH in Rwanda
active X
2,100,000.00
1.3.1.4: Convene a semestrial
stakeholders' symposium on One Health
No of stakeholders
symposium
conducted X X X X X 3,100,000.00
1.3.1.5 Develop and publish OH news
letter
No. of news letters
published X X X X X 10,000,000.00
Strategy 1.4: Mobilize resource for One Health
Activity 1.4.1: Advocate for
funding from partner
institutions.
1.4.1.1: Share the OH SP with partners
for future funding
No. of partners
who received the
SP X -
1.4.1.2: Organize annual fundraising
meetings
Report of the
fundraising
outcomes X X X X X
6,380,000.00
1.4.1.3: Identify and apply for new
funding opportunities/grants
No. of grant
applications X X X X X -
49
submitted
Goals 2: Strengthen surveillance, prevention, early detection, rapid response and control of zoonoses in both humans and animals
Strategy 2.1: To promote joint preparedness and response to zoonotic disease outbreaks
Activity 2.1.1: Develop an
integrated approach for
monitoring, collection,
management, analysis and
dissemination of data on
zoonoses and other public
health event
2.1.1.1: Workshop to review and adapt
existing surveillance guidelines and other
surveillance technical documents (SOPs,
data collection tools, M&E tools) to
emerging/re-emerging zoonotic diseases
and other public health threats
Workshop report
X X 31,882,620.00
2.1.1.2: Production and distribution of
reviewed and adapted surveillance
technical documents to emerging/re-
emerging zoonotic diseases and other
public health threats
# of reviewed and
adapted
surveillance
technical
document
produced and
distribute
X X X X X
5,100,000.00
2.1.1.3: Organize quarterly meetings for
sharing information on surveillance
activities in human, livestock, wildlife and
environment interface
# of meetings
organized X X X X X 14,356,440.00
2.1.1.4: Disseminate findings from each
sectoral surveillance system through
quarterly OH bulletin
# of OH bulletins produced and disseminated
X X X X X 11,274,186.00
Activity 2.1.2: Establish a
comprehensive system and
protocol for the surveillance
of diseases in wildlife within
the protected and targeted
non-protected areas
2.1.2.1: Conduct baseline assessment to
identify non-primate wildlife and related
diseases for surveillance system within
protected and targeted non-protected
areas
Baseline assessment report
X 33,000,000.00
2.1.2.2: Develop a harmonized
surveillance technical guideline for One
Health priority wildlife diseases
Document on
technical wildlife
surveillance for OH X X
5,100,000.00
50
priority diseases
Sub-activity 2.1.2.3: Improve the support
system for epidemiological data
collection, analysis and storage
# of collection,
analysis and
storage materials
availed
X
209,749,400.00
Sub-activity 2.1.2.4: Establish inter-
connectivity of wildlife surveillance
systems
Report on
establishment of
interconnectivity
of existing wildlife
surveillance
systems
X 59,200,800.00
2.1.2.5: Recruit staff to support disease
surveillance of in wildlife within the
protected areas of the country
# of staff recruited
for every national
park X
985,188,814.00
Activity 2.1.3: Develop
contingency plans for
potential zoonotic disease
and other public health
threats
2.1.3.1: Organize workshops for
elaboration and validation of specific
contingency plans
# of OH interest
disease with
contingency plan X X X 31,882,620.00
2.1.3.2: Organize Internal and cross
boarder simulation exercises to improve
operationalization of the validated
contingency plans
# of Internal and
cross boarder
simulation
exercises
conducted
X X 29,992,000.00
Strategy 2.2: To strengthen zoonotic diseases and other public health events surveillance, early detection, prevention and control
Activity 2.2.1: Support
existing surveillance systems
within OH member
institutions
Sub-activity 2.2.1.1:Extend the existing
gorilla surveillance system to other
selected primates
Report of
extension of gorilla
surveillance
system to other
selected primates
X X 16,449,200.00
51
Sub-activity 2.2.1.2:Maintain, upgrade
and adapt the existing electronic
surveillance system (eIDSR, IMPACT,
GAINS) and ensure their inter-operability
reports on
maintenance,
system upgrade
and inter
operability among
existing systems
X X X X X 27,417,600.00
Sub-activity 2.2.1.3:Establish electronic
surveillance system for livestock diseases
and unsure interoperability with other
systems in spirit of OH
Report on
establishment of
electronic
surveillance
system for
livestock
X X 27,080,320.00
Sub-activity 2.2.1.4:Support payment of
PBF (Performance Based Financing) for
OH appointed staff
# of PBF supported
staff X X X X X
134,343,929.00
Sub-activity 2.2.1.5:Purchasse office
materials
list of office
material
purchased X X X X X 63,559,474.00
Activity 2.2.2: Support
shipment of laboratory
samples at national and
international levels
Sub activity 2.2.2.1:Facilitate national
sample transportation from peripheral to
National Reference Laboratories
# of samples
shipped from
peripheral to
National Reference
Laboratories
X X X X X
524,001,032.00
Sub activity 2.2.2.2:Facilitate shipment of
samples to regional/ international
laboratories
# samples shipped
to regional/
international
laboratories
X X X X X 20,897,945.00
Sub activity 2.2.2.3:Procure specific
materials for specimen collection and
shipment
list of specific
materials for
specimen
collection and
shipment procured
X X X X X
323,306,000.00
52
Sub activity 2.2.2.4: Procure 5
appropriate vehicles for proper bio-
containment and safe transportation
between peripheral and central labs
number of
appropriate
vehicles for proper
bio-containment
and safe
transportation of
samples procured
X X
108,719,760.00
Activity 2.2.6: Strengthen the
implementation of joint
prevention and control
strategies for zoonotic
diseases and other public
health events
Sub activity 2.2.6.1:Organize workshops
for review and development of standard
operating procedures (SOPs) for pre-
analytical, analytical and post-analytical
activities
Workshop report
X X 31,882,620.00
Sub activity 2.2.6.2:Procure specific
materials for prevention and control
measures of zoonotic diseases and other
public health threats
List of procured
materials X X X X X
Activity 2.2.7: Implement OH
plans for jointly responding to
epizootics and other public
health threats
Sub Activity 2.2.7.1:Conduct joint
outbreak investigation
report on
investigation X X X X X
305,306,200.00
Sub activity 2.2.7.2:Conduct joint
outbreak response and management
evaluation
report of
evaluation X X X X X 13,688,698.00
Procure specific materials for case
management of zoonotic diseases and
other public health threats
list of case
management
specific materials
procured
X X X X X
Activity 2.2.8: Develop and implement a training plan for zoonotic disease and other
2.2.8.1.Organize joint TOT on zoonotic
diseases and other public health threats
surveillance personnel at central level
# of personnel
trained X 13,860,000.00
53
public health threats surveillance personnel
2.2.8.2.Organize TOT on zoonotic
diseases and other public health threats
for surveillance personnel at district level
# of personnel
trained X 32,780,000.00
2.2.8.3.Organize training on zoonotic
diseases and other public health threats
for surveillance personnel at sector level
# of personnel
trained X
343,008,000.00
2.2.8.4:Participate in regional and
international short courses on zoonotic
diseases and other public health threats
for surveillance personnel at national
level
# of personnel
trained
X X X X X
895,626,195.00
2.2.8.5.avail 3 PhD and 6 MSc. training
scholarships for surveillance personnel at
central level
# of personnel
trained X X X X 2,078,465,133.00
Strategy 2.3: Strengthen lab capacities to detect zoonotic diseases
Activity 2.4.1: Evaluate and
map out laboratory capacities
and resources in each sector
for detection of zoonotic
diseases and other public
health events.
Sub-activity 2.4.1.1: Conduct assessment
of laboratory capacities in existing
Human, Animal and Wildlife central
laboratories for detection of priority
zonotic disease
Assessment
findings report
available X
4,500,000.00
Sub-activity 2.4.1.2: Organize workshop
to review findings and prioritize
capacities to improve based on available
resources
No. of workshop
conducted
X 31,882,620.00
Activity 2.4.2: Establish
linkage of laboratory
networks between human
and animal sectors
Sub-activity 2.4.2.1: Conduct a workshop
to develop a framework for collaboration
and laboratory capacity
No. of workshop
conducted X 31,882,620.00
Sub-activity 2.4.2.2: Conduct quarterly
meetings to share regular updates
between laboratorians
No. of meetings
conducted with
minutes X X X X X 14,356,440.00
54
Activity 2.4.3: Enhance
existing lab capability (public
health, livestock and wildlife)
to diagnose specific zoonotic
diseases and other public
health events
Sub-activity 2.4.3.1: Upgrade the lab
biosafety level to handle priority zoonotic
diseases
No. of Laboratory
with upgraded
biosafety level X X 31,632,920.00
Sub-activity 2.4.3.2: Procure laboratory
equipment
List of equipment
procured X X X X X
151,824,280.00
Sub-activity 2.4.3.3: Procure reagents
and consumables
List of reagents
and consumables
procured X X X X X 1,768,861,560.00
Sub-activity 2.4.3.4: Recruit staff to
support lab activities
No. of staff
recruited X
555,288,241.00
Sub-activity 2.4.3.5: Implement
equipment maintenance and calibration
services
No. of equipment
periodically
maintained and/
or calibrated
X X X X X
128,373,120.00
Sub-activity 2.4.3.6: Identify and
participate in external quality assessment
schemes (EQAS) for tested zoonotic
diseases
No. of tests
performed with
EQAS X X X X X -
Activity 2.4.4: Develop and
implement a training plan for
laboratory personnel in
zoonotic disease pathogens
Sub-activity 2.4.4.1: Organize workshops
on Laboratory Quality Management
System and ISO 15189 Lab Accreditation
Minutes of joint
meetings within
the network X X X X X 65,532,720.00
Sub-activity 2.4.4.2: Training lab
personnel (i.e. Virologists, Microbiolgists,
Pathologists, Entomologists/
Parasitologists)
No. of personnel
trained per lab
specialty X X X X 17,460,000.00
Sub-activity 2.4.4.3: Conduct regional
and international in service training to
improve skills and knowledge of lab staff
on zoonotic diseases
No. of personnel
trained per in-
service training X X X X X
214,950,287.00
55
Activity 2.4.5: Identify and
establish cooperation with
regional and international
reference laboratories for
human and animal diseases
and other public health
events
Sub-activity 2.4.5.1: Identify and contact
regional and international reference
laboratories to collaborate for needed
capacities not available in-country for
human and animal diseases and other
public health events
List of regional
and/or
international labs
contacted X X -
Sub-activity 2.4.5.2: Establish legal
collaboration framework and partnership
with identified regional and international
reference laboratories to build and/or
support capacity to provide needed lab
services
No. of regional
and/or
international labs
with formal
collaboration
framework
X X -
Goals 3: Build capacity and promote applied research at the human-animal-ecosystem interface
Strategy 3.1: Promote OH approach in formal and informal training
Activity 3.1.1: Integrate OH
competencies into relevant
academic disciplines and
training programs
Sub-activity 3.1.1.1: Develop the OH core
competencies across undergraduate,
graduate and post graduate stages of
education
OH core
competencies
document
developed
X 15,006,600.00
Sub-activity 3.1.1.2: Develop
implementation plans for the integration
of OH competencies into curricula
Implementation
developed and OH
core competencies
integrated into
curricula
X 13,983,000.00
Sub-activity 3.1.1.3: Develop learning
tools to assist with implementation
Learning tools
developed and
used X 65,565,000.00
Sub-activity 3.1.1.4: Conduct
interdisciplinary faculty development
workshops to advance OH knowledge
and teaching skills
Number of
workshop
conducted X 22,918,000.00
56
Activity 3.1.2: Promote and
develop integrated advanced
training opportunities to
mentor and develop future
leaders in OH education,
research and implementation
Sub-activity 3.1.2.1: Conduct an asset-
based need assessment to identify
existing training models and resources
I 3.1.2.1:
Assessment
conducted X
678,000.00
Sub-activity 3.1.2.2: Expand and promote
existing integrated advanced training
opportunities (short and long term FELTP,
OH demonstration site, OH field
attachment, OH leadership,...) to mentor
and develop future leaders in OH
education, research and implementation
I 3.1.2.2: Number
of OH FELTP
supported long
course trainees,
Number of short
course OH FELTP,
Number of short
OH FELTP trainees,
Number of
functional OH
demonstration
site, Number of
trainees on OH
field attachment,
Number of OH
leadership
trainings
X X X X X
312,678,271.00
Sub-activity 3.1.2.3: Develop and
implement integrated advanced training
opportunities to mentor and develop
future leaders in OH education, research
and implementation
A novel functional
integrated
advanced training
program
established
X X X X X
145,183,329.00
Activity 3.1.3: Establish
faculty and trainees
exchanges and collaboration
across the OHCEA network
and beyond
Sub-activity 3.1.3.1: Establish a "OH
community" to link and inform scholars,
trainees and implementers on
opportunities for exchanges and
collaboration
OH community
established and
functional
X X X X X
57
Sub-activity 3.1.3.2:Create incentives to
promote exchanges and collaboration
across OHCEA network and beyond
Number of
exchange grants,
awards,
sponsorship
available, Number
of recipients
X X X X X
287,499,763.52
Strategy 3.2: Promote applied research at the human-animal-ecosystem interface.
Activity 3.2.1: Identify priority
health concerns at the
interface
Sub-Activity 3.2.1.1: Identify and
prioritize health concerns that are
amenable to intervention
List of priority
health
concerns available X 12,648,000.00
Activity 3.2.2: Identify and
promote applied research at
the human,animal and
ecosystem interface
Sub-activity 3.2.2.1: Using health
concerns identified above, develop and
implement applied research agendas to
benefit the health of Rwanda
Research agenda
developed,
Research carried
out, and use to
inform decision
makers and
communities
X X X X
Sub-activity 3.2.2.2: Design and
implement research to address existing
or anticipated zoonotic epidemics or
other public health events at the human,
animal and ecosystem interface
Research carried
out to address
existing or
anticipated
zoonotic
epidemics or other
public health
events and results
used to inform
decision makers
and communities
X X X X 1,174,319,205.00
Sub-activity 3.2.2.3: Create incentives to
encourage collaborative applied research
Number of
research grants,
awards,
sponsorship
available, Number
X X X X 93,414,408.00
58
of recipients
Strategy 3.3: Enhance national, regional and international networking with the scientific community on health concerns at human, animal and ecosystem interface
Activity 3.3.1: Hold national,
regional and international
workshops, conferences on
health concerns at human,
animal and ecosystem
interface
Sub-activity 3.3.1.1: Organize national
quarterly OH grand rounds
Number of OH
grand rounds X X X X X
2,016,000.00
Sub-activity 3.3.1.2: Organize
international OH conference every two
year
Conference held
X X
Sub-activity 3.3.1.3: Advocate for
inclusion of OH theme into existing
associations, fora and conferences
Number of
associations,fora
and conferences
with OH theme
included
X X X X X
858,000.00
Activity 3.3.2: Promote
writing and publication of
abstracts and manuscripts on
health concerns at the
human, animal and
ecosystem interface
Sub-activity 3.3.2.1: Support
participation in national,
regional and international conferences
addressing
health concerns at human, animal and
ecosystem
interface
Number of
participants
supported to
attend national,
regional and
international
conferences
X X X X X 86,249,929.06
Sub-activity 3.3.2.2: Organize
manuscript/abstract writing workshops
Number of writing
workshops
conducted X X X X X
756,000.00
Sub-activity 3.3.2.3: Provide financial
support to subscribe and submit
manuscript to peer-reviewed journals
Number of
manuscripts
published to peer-
reviewed journals,
Number of
subscription to
X X X X X
143,749,881.76
59
peer-reviewed
journals
Grand Total
RWF 12,594,616,131.34
USD 18,521,494.31
60
3.8. Appendices
Table 1:
1. Cholera
2. Bloody diarrhea
3. Epidemic typhus
4. Meningitis
5. Plague
6. Typhoid fever
7. Rabies
8. Viral hemorrhagic fevers
9. Yellow fever
10. Non-bloody diarrhea under 5
11. Non-bloody diarrhea above 5
12. Malaria under 5
13. Malaria above 5
14. Influenza-like illness
15. Severe pneumonia in under 5
16. Pertussis
17. Diptheria
18. Acute flaccid paralysis (AFP/polio)
19. Measles
20. Neonatal tetanus
21. Rubella
22. Viral conjunctivitis
23. Chicken pox
24. Mumps
Table 2:
1. Foot and Mouth disease
2. Rift Valley Fever in domestic ruminants
17. Bird Typhus fever
18. Tuberculosis
19. African swine fever in pigs
61
3. Actinobacillosis (Actinomycesbovis)
4. Fever disease caused by “coxiellaburneti” in
domestic ruminants
5. Infectious bovine
rhinotracheitis/infectiouspustulous bovine
vulvo-vaginitis
6. Rabies
7. Bacillus anthracis
8. Cowdriosis
9. Scab
10. Smut disease
11. Gumboro disease
12. Trypanosomiasis
13. Boreliaanserina in birds
14. Rinder pest
15. Psitacosis in birds
20. Cow respiratory disease
21. Salmonelosis (salmonella arbortusovis)
22. Bovine enzootic leucosis;
23. Contagious Peri-pneumonia
24. Brucellosis
25. Trypanosomaequiperdum
26. Mad cow disease
27. Pseudomonas Mallei;
28. Small ruminants plague
29. Swine fever;
30. Ovine ectima and caprine pox
31. Horse plague
32. lumpiskin disease, nodule dermatosis.
62
16. Peripneumonia in cows
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